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HomeMy WebLinkAboutMiscellaneous - 22 LINDEN AVENUE 4/30/2018F� IN Claim #033540772 Advantage Claim Services Adjuster Assigned: Glenn Guarente 522 Chickering Road #B North Andover, MA 01845 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec. 3B To: Building Commissioner dk Board of Health or Inspector of Buildings Board of Selectmen Town Hall _ Town Hall North Andover, MA 01845 North Andover, MA Re: Insured: Jason Wedge Property address: 22 Linden Avenue North Andover, MA 01845 Policy #: 34784400004 Loss of: 2015/02/08 File or Claim No. AD 1636 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. _ Gen. _ Laws,_Chapter_143,_Section_6 to be applicable. If any notice under Mass_Gen_Laws,_Ch._139_Sec._3B is appropriate please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Glenn Guarente Title: Adjuster On this date, I caused copies of this notice to be sent to the persons named at the addresses indicated bove by first class mail. 2-11-15 Signature and.date Date .11��k 4 t .................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..u'n-'`� ............................................................................................ has permission to perform , (�..................................................... wiring in the building of.. l .... v.............................................................................. at..........................................................................................PEAR North Andover, M S. t. "`+Fee........... Lic. No. V303.......... �7 2-v I -3 ECAL INSPECTOR Check# ZZZL2 V 12913 Commonwealth of Massachusetts Official Use Only a Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (Iv1EC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATIOA9 Date: A/o v 2 ¢ ,261 ¢ City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 2 2. LJ N P C N Ay r Owner or Tenant i4S aA-J WeO&IE Telephone No. Owner's Address 22 LI A1C)6 a A•y 6 Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of eters Number of Feeders and Ampacity F4 Location and Nature of Proposed Electrical Work: �AJ�y, t, C �D/vl Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires (P No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets + No. of Hot Tubs Generators KVA No. of Luminaires S Swimming Pool Above ❑In- [:1o. rnd. Rrnd. of mergency Lighting Battery Units No. of Receptacle Outlets /0 No. of Oil Burners FIRE ALARMS I No, of Zones No. of Switches S' No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number ' " Tons ."'""""..... KW . """ ""''"""'' No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: 1NSURA-NCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: _ Geod vE AC SM Pi3A 6Tt} G (Ec.T det c. LIC. NO.: f} 1326 3 Licensee: 6grv44 6 ,3' /4AtSAit 0 Tri' Signature LIC. NO.:—5 ZS J 3L (If applicable, enter "exempt" in the license member line) Bus. Tel. No. • 603 ^ 2 3 S -O 388 Address: / 3 14o 1,m Ef woo r> Petv6 .QAJ Do t4•ru AM 03673 Alt. Tel. No. *Per M.G.L c. 147, s. 57-61, security work requires Departrrlent of Public Safety "S" License: . Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) (] owner ❑ owner's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the s �� permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of.this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing hn'automatic'four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: - "N! 6te: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: - .. 1 Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 11CFailed IM Re- Inspection Required ($.) ❑ Inspectors Co ts: Inspectors Signature: Date: FINAL INSPECTION: Pass_. Failed � ' � �� ... "� 1 ' . - 'Re-'Inspe'ction Required ($.') b Inspectors Comments: Inspectors Signatu : Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department oflndustdalAccidents Office of Investigations 600 Washington Street Boston, MA. 02111 www.mass govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/.Plumbers Applicant Information Please Print Legibly Name (Business/Organi'zation/lndividual): &60966 J 4A SS1f?O -/IT- Address:- IAddress: 13 40 (Nes wa a n 00 ✓ e - City/State/Zip: <4,yo o w N N l[ 0 3 9 i 3 Phone #: 3- U S' - oW Are you an employer? Check the appropriate box: - Typo of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 6. Q New construction employees (full and/or part-time).' 2.)Q I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. �• Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance, 5. Q We are a corporation and its g• Q Building addition [No workers' comp. insurance required.] officers have exercised their 10.Q Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11. Q Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12.Q Roof repairs insurance . re uired required.] employees. [No workers' 13.Q Other comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showingtheir workers' compensation policy information. 7 Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that isproviding workers' compensation insurance for my employees. Below is the,policy andjob site information. Insurance Company Name: Policy # or Self ins. Lie. Job Site Address-, ExpirationDate: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). F. -Cure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP -WORK ORDER and a fine up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the AIA for insurance coverage verification. Ido hereby cerfify under the vaj4s andpenalties ofperjury that the information provided above is true and correct. Date: Nd v z4,7.0tcf Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - Vnnfn rf Pprcntn Phone #: ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an `1 electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the " notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date. Closed: Trench Inspection Pass ;Failed'0 ; ' - x • Re-460'Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass EN Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed M Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass IN Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pasn Failed ❑' Re- Inspection Required ($:) 0 Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com 1) :% 0. V Date........ `...13 TOWN OF NORTH ANDOVER PERMIT FOR WIRING l This certifies that........,.�..(?.(..../...L................................ has permission to perform ..........�1-P ...................................................................................... wiring in the building of .... 4, ex, e.,.......................................................................... at....................�...•P.... .............North North Andover, Mass. Fee..�,5 ......... Lic. No/oRpr ....N.�llJ..................... ............. ..... . ELE ICAL INSPECTOR Check # 11534 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071 (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) ;- �J#,Jo 1 j RjE, Owner or Tenant !Sa'r-o" W Gobs Telephone No. Owner's Address CoQ A -u Is this permit in conjunction ith a building permit? Yes No ❑ (Check Appropriate ]Box) Purpose of Building `� �� ti -c -Utility Authorization No. Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters Completion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires fo No. of Ceil: Susp. (Paddle) bans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. grnd. o. o Emergency Lighting Batteryits No. of Receptacle Outlets 7 No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches 52 No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Dis posers p Heat Pump Totals: Number Tons I.KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW p g Local ❑ Municipal ❑Other Connection No. of Dryers Heating Appliances 1 KW ,� Sectio. o of Devic : or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of , lee 'cal Work: (When required by municipal policy.) Work to Start: 4V Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C VE GE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE El BOND ❑ OTHER ❑ (Specify:) I certify, under the gins and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: 1St t6 L -t -c�d-iL SJS_ LIC. NO.: 1-20q? Licensee: -L7N P Signature ALIC. NO.: (If applicable, ent "exempt" in the license number line. Bus. Tel. No.• 6()3 `386 02 7 78 Address: C1 Qc�� /�{/ % / hf Wlf ' 0���3' Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work require Department of Public Safety "S" License: Lic. No. • OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: * ** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass M Failed EN Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: - Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Commentsl Inspectors Signature: Date: ]FINAL, INSP TION: Pass Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: va z. Date: DEB WEINHOLD ...TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 NZOV www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information s Please Print Legibly Name (Business/Organizaa{/ ttii/o�n/individua/l)�:j) %V y jJy^Z''1/ // City/State/Zip: Z`'�'/� �`� Phone 6 be - 30v _Z 7 ? 2 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I ,eiriployees (full and/or part-time).* have hired the sub -contractors listed on the attached sheet. 2. I am a sole proprietor or partner- ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance officers have exercised their required.] 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other, *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company N . Policy # or Self -ins. Lic. M. Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one. -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerci under the p 'ns an enadtier ry that the information provided abo a is tr a and 3 correct. Phone #: 01 og, - Zg Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - Contact Person: Phone Information and instructions ' Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract ofhire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in(city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department ofIndustriai Accidents Office oflavesagations 6.00 Washington Street Boston, MA, 0211,1 TO, # 61.7-7274900 ext 406 or 1-877�MASSAFE Revised 5-26-05 Fax # 617-7277749 wwwjUass.govfdxa , ,.-tELECTRICI-ANS itsuMTHIE,ABOVE ClbENSE li.,KENDELLEN S. I Date..... .... ........ . ....... K.;I" 16 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... :/ has permission to perform ..... wiring in the buildih ....... gof ..... at.... ... ........................... ............North Andover, Mass. ... Fee ... ......�... Lic. No .............. .. (.!..%.r/ -a.. L--/� .. . .......................... Check # 116 Z) 67 - ELECTRICAL INsPEc-r0R 5310 THE COMMONWEALTHOF DEPARTAIENTOF. BOARDOFFNE APPLICATIONFOR PERMIT' ALL WORK TO BE PERFORMED IN ACCORDANCE WITH (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Town of North Andover The undersigned applies for a permit to perform the electrical w Location (Street & Number) �,/ Z,i/f A, \J% Owner or Tenant Owner's Address /�C �% �1 _ I'1 __ - e, isthis permit in conjunction with a building ermi Purpose of Building m e–,P Existing Service A= Amps 120 10Yd Volts New Service _ Amps/0 Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 7TS Office Use only Permit No. (XI CM12 Occupancy &Fees Checked (PERFORM ELECTRICAL WORK MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 Date eo 02 D described below. vz Yes M No Overhead Overhead 0 41-q G W-174 To the Inspector of Wires: (Check Appropriate Box) –3/7 32--2-4 Utility Authorization No. Underground No. of Meters Underground No. of Meters No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round eround No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners No: sof Ranges No. of Air Cond. Total FIRE ALARMS No. of Zones Tons _ No. (& Disposals No. of Heat Total Total No. of Detection and Pumps Tons KW Initiating Devices No. �I' Dishwashers, Space Area Heating KVA' NQ: of Sounding Devices b WWSelf Contained _ Detebtion/Sounding Devices No. of Dryers Heating Devices KW Local Municipal Other'. Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP >THER- sulanceCoveiage AnuanttotheiegtmmrntsofMassachmmCVDCdLaws >aveaomentLmbltybstnancelohcyiwhxmlgComplEe CoverageorZatsW%alegrmiat YESED— NO gwabmittedvalidpcoofofsarnetothe Offim YES Ey mbavectledodYES,plea mdc&thetypeofoo by JSUthe ' box I)NCE� BOND r7 CTI -IFR r7 (Please Spa*) ExpiiationD& EstirnamdVahleofElDctriralWoik $ oiktoStart hispearonD&RWsted Rough Final Ped uroer eFtnaitiesofpeijuly. r ? ZMNAME L 'C r t /! G"S ei� Ii��/No. �� %7 enseefXJ�liL��ivyl �_<Ir1/r1G317 Signature ---- LiomseNO l BusuiessTelNo. -33 S Doman e,, -L1 s 5�— Alt TeINo. VMM'SINSURANCEWAIVER;Iamawaiethat theLicensedoes nothavetheinsuiaricecoveiageorifssul alec ivalentasiaTmedbyMassachus2ttsCeriei-alLam that my siJnah,rn on this panrit application waives this ieglmmrnt ease check one) Owner ® Agent Telephone No. No. PERMIT FEE $ signature oT Owner or 77gent The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston; Mass. 02111 Workers' Compensation insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone #• Insurance. Co. Policy # Company name: Address City: Phone #• Insurance Co. Policv # Failure to secure coverage as required under section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonment_as well_as_civil.,penaltiesin.1befarmof-a:.STOP WORK ORDER.,and_a.fine-of.(.$1DO.DD).a-day-against_me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing ❑ Building Dept ❑Check if immediate response is required ❑ Licensing Board Contact persona p ❑ Selectman's Office Phone ❑ Health Department ❑ Other e 4� MXSSXCAUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print of Type) n NORTH _ANDOVER, , Mass, Date Iv � 0 ` 1g0 Building Permit # *z Location �, l �-. � ���� �v � Clea New M Renovation ❑ Owner a v Name _ �;(>,9,eJ LLr C Ic Replacement 10 Plans Submitted: Yes ❑ No C7 ' Check one: Installing Company Name_ 1 c 0.o ,I—, — 3, Q Corp. Address-_-- h \� �,.--- d Partnership 1�1us� I� Firm/Co. Business Telephone Name of Licensed Plumber or Gas Fitter _ �� a 1 �� `,, 0 "N INSURANCE COVERAGE: Check one have a current liability Insurance policy or Its substantial equivalent. Yes V No ❑ If you have checked .yes, please Indicate the type coverage by checking the approprlate box. I A liability Insurance policy Other type of Indemnity ❑ Bond ❑ Certificate OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: nature of Owner or Owner's en Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) M above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be In compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws TyDe of license: L Title Plumber gne urs o nae u er o as er Gasfllter � � Master License Number '�OWn ❑ Joumeyman APPnUVED (OFFICE USE ONLY) wrwrwwwwrwwww�wwwwww�rrwwww■ ..• wrrrwrwwQww���wl�wwwwwrr�rrr■ ' .- i�wrrwrrwwwwwiwwwwwwwrwwwwwww■ ' "• rrrrrrwrwrw��wwwwrwwMwrrrrrr ., .• rrwwrrwrwwwrwwwwwwrrrwrrrrr■ W. ' wrrrrrwwr�wwwwrr�rwrwwwwwrwr■ CEMMONNONOMMONOMMUN rwwrrrrrrrr■ CM rrrrrrrrwr�wr�w�r�rwrrrwrrrrrr ..: rwrww�rrrrww��w�r��rwrwwrwrww ... rrrrrrrrrrwrrrr�rrrrrrrrrrr■ ' Check one: Installing Company Name_ 1 c 0.o ,I—, — 3, Q Corp. Address-_-- h \� �,.--- d Partnership 1�1us� I� Firm/Co. Business Telephone Name of Licensed Plumber or Gas Fitter _ �� a 1 �� `,, 0 "N INSURANCE COVERAGE: Check one have a current liability Insurance policy or Its substantial equivalent. Yes V No ❑ If you have checked .yes, please Indicate the type coverage by checking the approprlate box. I A liability Insurance policy Other type of Indemnity ❑ Bond ❑ Certificate OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: nature of Owner or Owner's en Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) M above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be In compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws TyDe of license: L Title Plumber gne urs o nae u er o as er Gasfllter � � Master License Number '�OWn ❑ Joumeyman APPnUVED (OFFICE USE ONLY) z _O f - U W 0. N z N N w a 0 0 a n. N w z v w Y N + z , o o _J Z a z• ' m u LL f•• • a W h N z_ LL 0 J • Z . t7 � O 2 O O LL w p CLL. ; N , + w U � 0 Q o Z F- � a W a c O � ' Ir CZ o _O a w ' m m ' Q u • J IL AL IL t ' w w IL N w z v w Y N n � ! z , t o _J Z a p ' m u LL W a W LL N z_ 0 J . Q � U 2 O LL CLL. n � ! Z ; , t C7 _J Z a p ' m J LL O , �p W LL a 0 z 0 U ,Q 1 � U a _ O t ! , t 1 . a t' CLL. ; N , +; Q b � ' o a w , m ' O IL 1. 1 b Date ... /// ,%ORTH TOWN OF NORTH ANDOVER 0 0, 0 T. PAM FOR GAS INSTALLATION 16, �Zq SA U 0 This certifies that ....... ............ has permission for gas installat .. .... .. in the buildings of . ...... .. .............. at .2. ........ North Andover, Mass. 6q) Fee. 2.$-. .-n Lic. No��'�"j -(,/ ... .......................... (411( 41 "7 6�0 GAS INSPECTOR WHITE: Applicant -_,CANARY: Building Dept. PINK: Treasurer GOLD: File :1 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) NORTH ANDOVER Mass. Date 11 / 2 7 1 g 91 Permit # Building Location 21 Linden Avenue Owner's Name Gillick 1 �/ Im — Type of Occupancy RESIDENTIAL New Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE, MA 01840 Business Telephone 508-687-1105 Name of Licensed Plumber or Gas Fitter Check one: Certificate # �] Corporation 6 4 C ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 1:1 No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ® Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent ❑ hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and th�atrah° Imbi wo�kand�tnstallatios performed under the permit issued for this application will be in compliance with all P 9 pertinent provisio � f th nMa�saot usejrtts til iatkas b de and Chapter 142 of the G La By — I _ e! of License:'j1 Title i I r 4 �' Plumber Signature of Licensed Plumber or Gas Fitter Gasfitter Master License Number M-429 City/Town+ _ _ -- Journeyman Ar PFK)W-f) ((.)f (1Cf l� �E OTIA -t-- R�%I�Lyr►�? DFPA iTME:N-� • ■����t�e�����■ SON■ SEMI ■MENEENNON ©NO a tINIENOUNK ... ■������������t�nln�s�ONES • • ■�����������������NONE MEN • • • • ■�����������������0800 now OMEMENO ENO ENO Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE, MA 01840 Business Telephone 508-687-1105 Name of Licensed Plumber or Gas Fitter Check one: Certificate # �] Corporation 6 4 C ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 1:1 No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ® Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent ❑ hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and th�atrah° Imbi wo�kand�tnstallatios performed under the permit issued for this application will be in compliance with all P 9 pertinent provisio � f th nMa�saot usejrtts til iatkas b de and Chapter 142 of the G La By — I _ e! of License:'j1 Title i I r 4 �' Plumber Signature of Licensed Plumber or Gas Fitter Gasfitter Master License Number M-429 City/Town+ _ _ -- Journeyman Ar PFK)W-f) ((.)f (1Cf l� �E OTIA -t-- R�%I�Lyr►�? DFPA iTME:N-� J z 0 w N w U LL LL O a O LL O J w a d z• t- LL N I d O a O I- t t- o a v w Z a J O LL C=7 z W O 0 t' a w a. U ?. a w a � to Q toIj- z a LU r LL N a v a 0 a w m a O z d J 56 Date .... A. ...... '�R WN OF NORTH ANDOVER �MMFQR GAS INSTALLATION 11161U - AR ....... This certifies that .......... has permission for gas installation in the buildi�gs of ...... le e iL at .;::)l North Andover, Mass. Fee. /7,17��Lic. NoM. '12-.1 . .......................... GAS INSPECTOR WHITE: Applicant(l/." 'liAW ng Dept. PINK: Treasurer GOLD: File 6 N2 V/75 Date.. �� ..... a. 0- TOWN OF NORTH ANDOVER CIC PERMIT FOR WIRING This certifies that .... ........... .................................................... has permission to perform ............................................................................... <Z� CM wiring in the building of .. 02 - at ... North And9ver, Mass.' Lic. Nd ....... . ............. . ... . ......... . ........................... ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer TBE CJ9MhI011 WEALTH©FMA-RSAC7ffJSE77S Office Use onlv n DEPARTI KENT OFPUBLICSAFETY t51 Permit No. BO* OFFNEPRLVEM70NREGULA770AS527CMR 12-00 Q Occupancy & Fees Checked APPLICATIONEOR PERMT TO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE 1 (PLEASE PREN7IN INK OR TYPE ALL INFORMATION) Town of North Andover The undersigned applies for a pe iF® t e mit ical w rk Location (Street & Number) Owner or Tenant Owner's :Address PERFORM ELECTRICAL WORK 1ASSACHUSSTS > .FcrRICA. CODE 527 as 12.00 MAP ero� Date To the nspector of Fires !scribed b 1IRMCEL oe Is this permit in conjunction with a building permit: Yes L—_L-J'1�0 L__J (Check Appropriate Box) Purpose of Building/j(��j .LA,2 �/���/�/�� No. of Transformers Utility Authorization No. Existing Service Amps / Volts Overhead Q Underground No. of Meters Ne"v Service Amps / Volts Overhead Underground No. of\Meters 0 umber ofFeeders and Ampaciry �o ofLiahnng Fixtures Swimming Pool Above Location and Nature of Proposed Electrical Work !J No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA �o ofLiahnng Fixtures Swimming Pool Above Below Generators KV.A and around No. of Receptacle Outlets / No. of Oil Burners No. of Emergency Lighting Battery Units NO 01 JwIICh DUIICIS No. of Gas Burners FIRE ALARMS No. of Zones No of Ranges No. of Air Cond. Total Tons No. of Detection and No of Disposals / No. of Heat Total Total / PUMDS Tons KW lrtivating Devices No. of Sounding Devices No of Disnwasners Space Area Heating KW / No. of Self Contained Detection/Sounding Devices Ji Dryers Heating Devices KW Local a Municipal Connections Other Ny of wale: Hearers KW No. of No. of Sins Bailasis No Hccro ,Massage Tubs No of MolOrs Total HP I OTHER Cu - to ic .an [E� 11110 F7 :,,e subrrmsd vafid.•or • •ffir YES • Tpropriae .o NSLJRA.]�CE BOND F7 7-11R Fease Specify) ♦ p • •. 1 •n as . r. CN:•r « a• �> 20 t)/2 Sim ' OWNEtt'S PvS-R-,uNCE W.AIVER; I an avate diatdie Lim does act have and m my siattaecn this p=m am6= rt wanes the tttluilm= (Please cht--k one) Owner Agent Li�seNa TdNo A:: Te<' Na rt au—r= X Ymg� a -as Stfgrxzl t i "a l as req =2 by Massalaamts C 1 Las Telephone No, PERMT T FEES D. Location No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL '13'185 06/15/99 14:41 $ A/ z4e ��. Building Inspector 175.00 PAID Div. Public Works h F 01-1 W ¢ � W G w O � � U c o � c w a c in U O O O z a � O O d x 0.o n � F U F U U z i C w o Z Z p z c� m I A V z U. w �� A u N , nw m F z o c F H O O F o H z o a a F z ¢ ¢ a C ;4W G Z F � a M_I Urn! CA cn - w w O p F w Z C7ZZ O O- Z z M o p o z o w z z z �� p 6 z o o W z w z z w_ z= w U o W F C d C C w w un W i iW 0 lk h F 01-1 W ¢ � W G w O � � U c o � c w a c in U O O O w a O O d 0.o n � F U F U U z i C w o Z Z p z c� m I V U. u a C F 01-1 W ¢ W G w O � W U c o � c w a c in U O O O w � w o N , nw m F z o c F O O F o H z o a a F z ¢ ¢ a C ;4W G Z a u a C v F 01-1 W ¢ W G w O � W U c o � c w a c in U O O O w v F 01-1 W ¢ G w O � x w \ c o � c w a c in i OEPAR1NtNT �j,10 SI�fE1T� `�C ' I '► ...�iii;:. (ONSAUtTION SUPERVISOR tIc(list , A Nupbor: + txplres: MOO! (S 111152 19/28/1999 19/21/1961 Rectrietee lo: 11 HAI I PO ROM JR)III UPION AVE N R(AOIN6, NA 11861 (( \ ;SAI iM 1M IN PI�MW�/,A � ,�/IRWI�fA,M IJ 1• �\ 110ME IMPROVEMENT CONTRACTOR f Registration 100804 . Type - PRIVATE CORPORATION Expiration 06/23/00 M.G. IIALL CONTRACTORS, INC i ��•r+,c f rcy k G. Nall N)MIfJ19111A11 )11 v -I Upton Ave/P.O:. Box 383 N. Read ino MA 01864 ... ...� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone aI am a homeowner performing all work myself. aI am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Comoanv name: /f'%, G-� i�L� �o I c %2/�� Address f 4 -3 City: pIyU /,0*, O /8C* Phone #: 9 Z? Insurance Co. Z-1-44-oA-) POlicv # 1-7,8 (]i) Comoanv name: ZQ4 J Address 23 C�G°�'SxJ c1 % Ow Z) City: 1W,4- - d /P 6' 7 Phone # Permitlt_icensino Building Dept /✓�t7r' ❑ Licensing Board ° �_ -®InsuranceCo.,S,hv4-i7)s 3 Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. do hereby certdy under the pains and penalties of perjury that the information provided above is true and correct Signature a5rdA, � v c3ZZ Print named4,!? L L Date 6--10' 99 Phone # 77,E -16-J-6 Official use only do not write in this area to be completed by city or town official City or Town Permitlt_icensino Building Dept ❑Check if immediate response is required ❑ Licensing Board [j Selectman's Office Contact person: Phone n ❑ Health Department F Other s North Andover Building Department Tel: 978-688=9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant 6- -- la - 9,9 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 9 � w O p� o W° v n cn u z Q o cz wE t C4 v U w a �'' 'no C4 w a � U "'� w 'C°D w2 cin c w O w z C7 to w w c w v c w' d z co v Q o C/) o aOC :,F o �. Cw O C w. o V � cc R R CD C O � N f :EQ L m C C :.c w «. !ei Q N E C :.o m o'" m c N R CD � N m C_ m C � CO) R N E� C -v ® N m m Ql.... C N ' ® o 'CDC C, R >= o L w F... h CL CD CD m: O � CL COID W =O fl S U -m C "" •N W �E 5�N � o 0 0� c C** CL CL rte.■ m co 0 CD L 0 p C.) z CO C. O Cn ICD CO2 � 'a a) CO CID i O CD CL CD CD CD CL C/! O � � CJ CD CL .� U CO) CCs C c CL y O 0 C/) CcW W Ir VJ Location---- -�Iqv S)e,W�,-� No. c;23 Date x, //0 40PTot TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ CHU Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL CZ Building Inspector 3) 33 06/15/99 14:42 25. 00 PAID Div. Public Works Q C/) F z U c F U OO U W z U U L i w � v a z w i C N o d W N O � O a w tC- O E cn N ¢ M z z � 0 0 'Q F V) h Ul L c; C6 W O U cz a l.�tu m z G w -k -k z � � w Q A w a (,✓ LJ y fn Carl C}a] a 'A F (n 0. V Z V O COD z Z Z U. pZ" O W O O V }r p w Ln w �, O C O O Ow Z z a O O. w O L rw C z Z W Z w Z W U w L� W N A. z m h vdi A A ❑ ., c z 0 Q V a a ¢ \ O ,✓ F O m C V, � c A t4 N W F kF7 F „zj Q z0 C .__. W CCl) a z a w 3 G F r C N yU� a w w w -•� z z Z�„ CA w Ln i a w 6. U i W C/) F z U c F U OO U O U U L i w � v a z w i C d W N i � O a w tC- O E cn N ¢ M z z � 0 0 V) h Ul L c; C6 W O U cz a l.�tu m z G w F �wi U U OO O U U 03 I t xAd v C/)° v � U Q to cri U � W coW a uW a U c4 u C � C7 to G�Ow w w a w a w'w o cn Q O cn -4ft. c o CO c c C.1 o C N0 O C M O O V •dam :ac M M m c .r cv N � ECO W. Q r+ cEcoO :quomw t V N Es O L CJ O O CD c N �C mCD of cm C C � �r m O ,0 N O SEN m CL 2 Na : mmmc �z O ao H m N C = m m r O � a y +O+ N W 4;_...�_ LL O % C �N A R f•' N C = C= C W v cm V2CL CD O co, cl ` N ._ C w,., m L 0 V CO CL y C G3 CM C CID co 0 co A D CD o o Q. CL cma CcM 0 co Q CL H C W co 0 co A O a r�' � I CA co Q co CDCL N r CJ) Tco; ti N o 0 CL c m C/) �' o C.3 cm m r� U y o c U V cm c •C N �S C o CL o C L 0 V CO CL y C G3 CM C CID co 0 co A D CD o o Q. CL cma CcM 0 co Q CL H C i I 1 � 1 1 Re 1 � 1 1 Re 'lOME:.,c-IMPROVEMENT CONTRACTORS REGISTRATION ard:-of..Bu rlin`Regulations and Standards i ;One, Ashburton Place —., Room 1301 t ,+ Boston, Mass'achuetts.021.08 r i HQM� 'IMPROVEMENT 'CONTRACTOR L--- ------ --- --, --: -- -- - R.b`Qi9tra�:i:on 100712 ExPz� ata an Q6123/00: T,Ype ' ,.DESA �: T,4 6 m�� i �l ,macltuj iI HOME IMPROVEMENT CONTRACTOR i Registration 100712. CMQRL.ES J WC)OSTER ROOFING j Type - DBA :1 ;ha�rTes `•J �. Wooster. Ezpiretion 06/23/00; ?525,,.WOBURN ST ' 1`EWKSBURY MA. 01876-..i' CHARLES J. WOOSTER ROOFING ? Charles J: Wooster eq aW WOBURN ST a ADMINISTRATOR iEWKSBURY HA 01876 i �i CONSTRUCTION SUPERVISOR Number: Expj rE!s: CS 0'511268 F9511112(wr9 Restricted To:' 00 CHARLES l WOOSTER PO BOX 8051 LOWELL, MA 01853 01AIARI*MlA l' Of PIP -11. 80'31'ON , M."ll Bt.1Id�,t�-: H5 /'1.1. /.1961 Keep top for receipt and change of jiddrt>s notification. Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT Director (978)688-9531 (v thio os ryO Z2, e° •� 0 x Q�(4�Tt0-�PPy�(1 Fax(978)688-9542 In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: �a-5C-� (Locatior),� z�J-JVvl /V ility) Sign Lure f Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 683-9530 HEALTH 688-9.540 PLAT iNING 688-9535 PROPOSAL t!777 "WE'RE ALWAYS ON TOP11 ALL TYPES OF ROOFS CHARLES WOOSTER OFFICE (978) 251-7181 FAX (978) 251-0159 Put Your Poof uYzdcr ihoprotictlon of Cur Umbrcfia P.O. Box 8051. Lowell, MA 01853 E -Mail: ILOVE ROOFS@ aol.com Proposal Submitted To Work To So Name Connie -P Street Sire9 t 479 S-ttivens St. city An Q0 Y--� State— ip Qode. . ............. .. . AL State KA —Zlip Code. O.L 8 4 5 Fax Number Telephone Number 689-3514 Telephone Number 7 ---2 9. jo We hereby propose .to furnish the materials and perform the labor necessary for the completion of the following job. Strip the entire roo-f down to the rood deck. Replace anv rotted roof deckina._at w$2 X00 tjL_Ahee.t or sheath, over, tiie e:tistinq roof dick an additional $1,350.00. 2. --' n s t a 11 8, aluminum. . dr 1-� e cla, e . I C 3. instail 6 of. lce.and.water barrier. P&per --eincaitdej-: cif . roof with fiberglassed Too--in-.felt , 5 install. Bircl Seal Xing 2.5 gear shingles, hand nailed. 6. Ir.stall new, flanges. 7. Counter 1 ash.. chiranev f lashinqs with roof cemen-L., 8. Cle'eLrl: and dis-pose: of all. debris, Workmanship guaranteed for 10 years, We are fully insured with workers' compensation as well as liability insurance. Please return copy of proposal s t 5 /w All material.is guaranteed to be 8 1 in accordance with tions submitted for above work ai tittw"-4-Dollar ($ 31500.00 Witt n P1 r te I -T' proposal 64ih4�yE be withdrawn b Call For Our References Traw y, Full In'sured' y 1 n ccepted within 30 days -3 The above prices, specifloatio ccepted. Youare authorized to.do the work as specif led. Payment v Date J3 _N MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING tPrint or Type) Ll• Xw? ,10DL/�YL- .Mass. Date Oe -7- /-e 19__fZ permit # 26 20 G Building Location__ b r-- AJ �-Owner's Name_ S ,Z 0 Z j lir Type of Occupancy & S1,!J New ❑ Renovation Replacement ❑ Plans Submitted: Yes[] No ❑ Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE, MA 01840 Business Telephone 508-68,7--:1105 Name of Licensed Plumber or Gas Fitter Francis X. Corkery Check one: Certificate # )O Corporation 1862 ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 9, No ❑ If you have checked Yes. please Indicate the type coverage by checking the appropriate box. A liability insurance policy X Other type of indemnity ❑ Bond ❑ OWNER'S -INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Owner❑ Agent ❑ ggent I hereby certify that all of the details and information I have submitted (or entered) in abo plication are true and accurAte to.the best of my knowledge and that all plumbing work and installations performed under the permit Iss f r this application will n mpliance with all Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. T e of License: Title Plumber Signature of cense Plumber or Gas Gasfitter City/Town Master License Number 8697 O FIC SE O L Journeyman Y • ■�f�i��t�l��,�i��■ NEI MEXIEN on ONES MENNEEMENUMMEMMENon ON ..; ■INENNOMENNO MEMO NoSEEN n■ IS K •• ■��������������0t���r�■ son MEN mom Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE, MA 01840 Business Telephone 508-68,7--:1105 Name of Licensed Plumber or Gas Fitter Francis X. Corkery Check one: Certificate # )O Corporation 1862 ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 9, No ❑ If you have checked Yes. please Indicate the type coverage by checking the appropriate box. A liability insurance policy X Other type of indemnity ❑ Bond ❑ OWNER'S -INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Owner❑ Agent ❑ ggent I hereby certify that all of the details and information I have submitted (or entered) in abo plication are true and accurAte to.the best of my knowledge and that all plumbing work and installations performed under the permit Iss f r this application will n mpliance with all Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. T e of License: Title Plumber Signature of cense Plumber or Gas Gasfitter City/Town Master License Number 8697 O FIC SE O L Journeyman z - o U W ' O. N _Z N N w a n 0 c CL n z• H W N � Q J n z O . O W O N 1•' W H . � o 3 x o w 0 W Q wa m V J � p•' •a a a W w � w,•• a x i wl a 0 a W m a O z J r) 2 6 7 0 Date,/. /�f ORTN TOWN OF NORTH ANDOVER 16 0 PERMIT FOR GAS INSTALLATION SACH S A, This certifies that ................ ...................... 1 -0 has permission for gas installation j�' XA ................. —.. in the buildings of ............................. at ..?. rl,-, ........... Mass. Fee—..�'.... Lic. No..O..,' ... WHITE: Applicant CANARY: Building Dept. PINK: Treasurer f. N2 4081 Date. TOWN OF NORTH ANDOVER -PERMIT FOR PLUMBING This certifies that ... . .... ........ has permission to per orm ...... .. . ... .................. plumbing in the buildings of . ............ a t ..................... No And over, Ma ss. Lie. 140/5��/3 ..... ......... . . . ......... PIL ING N ECTOR 07/16/99 14:22 28-00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer (Type or Print) NnRTN ANnOVPP Building Location ,Mass SAP:,_ QZ L 1 1 D e rin Replacement 4• . Oate: Permit 1G bC�c vv, till Plans Sybmitted (Print or Type), installing Company NameVV Address �� Lq�vS 54: &oe V37 Check one: Certificat@ Corp' Partner. Cj FirmlCo Business Telephone /,.5 U- ty ZY Name of Licensed Plumber: 'e-5 C®rin� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 0 Other type of indemnity F-1 Bond Insurance Waiver: I, the undersigned, have been made aware- that the licensee of 1 this application does not have any one of the above three insurance CQYerage5. Signature of ownerlagent of property Owner Agent'. I I barcbr ccttirr Lhat all u( tltc dctaill and in(oiniaiian I lu.c iutimiI Icd for cnicicd) in abooc applicatiow are 1,ac ++�d� Sti to Ora bait r w �. krwwkd96 sod lhat all plumbing crock and inrlallalincu pco(nimcd unJu_ fctmit litucd for this appli"liow wilt ba k caupliawp .itb W patina" P•I chis" at Wa 14aatacJturctlt $la/c Plumbi4 Codc and Ciuptcr 142 a( U4c (;" al La. L. ,r By - - - Title City/Town: A DDC:r)vrz l 70FFlrF USE ONLY1 gn4ture (Zf Licensed Plumber Type of Plumbing License License Number YJ Master 1:1 Journey"4 3216 Date .... �� ILI-. fy .... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that has permission for . gas Litallation, in the buildings�'bf ... ....................... at ?.-P ... ...... ................. North Andpiver, Mass. Fee.,4� ..... Lic. No./IR5 /-i . . . . k_ GASINSPECTOR WHITE: Applicant CANARY: Bui4i:ngl Dept. PINK: Treasurer S 0 MAP 0 ?- Z PARCEL G Ud �UWQ PLICATON FOR PER1VLiT DO G AF=G— or print) Date ivvxfH ANDOVER, MASSACHUSETTS Building Locations A) C/,l cel -Ael Owner's Name New ❑ Renovation F'L Replacement ❑ /,?'19/ / Permit # Amount Plans Submitted ❑ (Print or type) n n ` ) Check one: Certificate Installing Company Name AD�1C of r0 Qc7l/l u M'� / L / Corp. Address _ - I aL6C�S r S�O �pk ❑ Partner. Business Telephone77-4q-71c/❑Firm/Co. Name of Licensed Plumber or Gas Fitter 5o,meS �P,ell YtS �1� INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes iM Nom If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy Other- -e of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Sienature of Owner or Owner's A-ent Owner ❑ Aizent ❑ I hereby certify that all of the details and information I have suhmitteri (or entPrrrh , k-- best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in v compliance with all pertinent provisions of the Massachu tts S to as C e and Chapter 142 of the General Laws. bv: Title City/ own APPROVED (OFFICE USE ONLY) V Stnm ature o�censed Plumber Or Gas Fitter Pber . /� 5 ' ❑ Gas Fitter IcenseI u oer ®' Master ❑ Journeyman Y 12N D FLO OR JR D FLO OR (Print or type) n n ` ) Check one: Certificate Installing Company Name AD�1C of r0 Qc7l/l u M'� / L / Corp. Address _ - I aL6C�S r S�O �pk ❑ Partner. Business Telephone77-4q-71c/❑Firm/Co. Name of Licensed Plumber or Gas Fitter 5o,meS �P,ell YtS �1� INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes iM Nom If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy Other- -e of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Sienature of Owner or Owner's A-ent Owner ❑ Aizent ❑ I hereby certify that all of the details and information I have suhmitteri (or entPrrrh , k-- best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in v compliance with all pertinent provisions of the Massachu tts S to as C e and Chapter 142 of the General Laws. bv: Title City/ own APPROVED (OFFICE USE ONLY) V Stnm ature o�censed Plumber Or Gas Fitter Pber . /� 5 ' ❑ Gas Fitter IcenseI u oer ®' Master ❑ Journeyman Date. ..7 ..... . 0-0�� 10 NORT1y pF ao ,°'y0 3= °` TOWN OF NORTH ANDOVER -,� PERMIT FOR GAS INSTALLATION • o i This certifies that .. c: F:. . .......... has permission for gas installation .... �--/ . �- ................ . in the buildings of ..(�-. siG. ...................... at ..9 .? ..Z./ 'f ' - ...... ` '...... , North Andover, Mass. Fee.../." Lic. No.% �!. '... GAS INSPECTOR Check # 6024 A FIXTURES MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING CitylTown: O ' 1� c%.y E- R MA. Date: C d ' Permit# N � � �� Building Location: c2CA Owners Name: 6 Abe' .. Type of Occupancy: Commercial ❑ _ Educational ❑ Industrial ❑ ,Institutional ❑ . Residential ❑ New: ❑ Alteration: ❑ Renovation: ❑ Replacement: <P?r, Plans Submitted: Yes ❑ No ❑ FIXTURES INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 2- Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box ❑; I hereby certify that all of the details and are true accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: By [lumber Title ❑ Gas Fitter ignature of Licensed Plumber/Gas Fitter ❑ Master Cityrrown 2journeyman License Number: f -S 7 APPROVED OFFICE USE ONLY ❑ LP Installer LU Y Z EW.. 1% i O to OC = fA to U 0 O J_ } � Z z 0 Z rn W W W Z O w O U W 0 W Q o Q Z O V LL re > to V W to Lu 13 0 Z z 9 = is W I— W O W M W. W W W Q O W J LL U) F W III III Lu F- W 0 V o Q D LL C9 W (7 x W 2_3 Q> 0 0 a 0 0 Q: W F- Z >> W Q Q Q I=" O SUB BSMT. BASEMENT 15T FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOOR -PrFLOOR 7 FLOOR 8 FLOOR �-- / Check One Only Certificate # Installing Company Name: C�e h h L e m l p r El Corporation Address: doe '6omtv'" SAity/Town: ` � State: %��� ❑Partnership Business Tel:/ Fax: ❑Firm/Company Name of Licensed Plumber/Gas Fitter: INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy 2- Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box ❑; I hereby certify that all of the details and are true accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: By [lumber Title ❑ Gas Fitter ignature of Licensed Plumber/Gas Fitter ❑ Master Cityrrown 2journeyman License Number: f -S 7 APPROVED OFFICE USE ONLY ❑ LP Installer s z 0 U W v: C v: W O 1 a .OW � 0 � Q O C] o A z � ° w a Conv: m ❑ - � a a a z r/I � [. w z 0 F U W z � U w x a � Date . V. D�A .. 'AORTH TOWN OF NORTH ANDO PERMIT FOR PL WfNG This certifies that ... ..... J. /:-nt—rf. ............. . has permission to perform ....... ........................ /, r A 5 plumbing in the buildings of .... / ............................ at ... 2. r — /-�l -.......... ............ North Andover, Mass. Fee... ? Lic. No . ......... ...... PLUMBING INSPECTOR Check # W -V 0 — 7406 I MASSACHUSETTS. UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: /U O Iq R/bcl VC e , MA. Date:6Z 7�G 7 Permit# Building Location: VC Owners Name: G O�jj Pry Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential ❑ New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes ❑ No ❑ FIXTURES I have a current liability insurance policy or its substantial equivalent which meets the requirernents of MGL. Ch.142 Yes ❑ No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy - Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Sianature of Owner or Owner's Aaent I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: . Title Plumber Signature of Licensed Plumber City/Town ❑ Master License Number: APPROVED OFFICE USE ONLY ..�urneyman z z y z Z fn N 0 V N N N a. iz z H Y Q N a a N Z D Q U)_ iL W 0 W a r~ Y U) OJ d X ca O� a O a W 0'm W N W-1 z 0' fY LL .fA aN N3UQa00°Y.W° a z P P Wx a a N a0 0= Q a a a Q m m 0 Cl LL 0 2 Y. J J W W to 0 SUB BSMT. BASEMENT J 1 -FLOOR 2 Nu FLOOR 3 FLOOR 4 FLOOR 5 IHFLOOR 61H FLOOR 7 FLOOR 8 FLOOR /� Check One Only Certificate # Installing Company Name: (f P,6;q �-p /fir . ❑Corporation Address: )00 t�6 /�/%row S� City/Town: > ` e4-" State: ❑ Partnership Business Tel: Fax: Fax: ❑ Firm/Company Name of Licensed Plumber: I have a current liability insurance policy or its substantial equivalent which meets the requirernents of MGL. Ch.142 Yes ❑ No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy - Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Sianature of Owner or Owner's Aaent I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: . Title Plumber Signature of Licensed Plumber City/Town ❑ Master License Number: APPROVED OFFICE USE ONLY ..�urneyman z 0 W G W C7 O a 0 0 C7 a U U F m w w a z O c' W a z i _? A U cn � � Z w a z 0 x 964 F z W W LOD Q z w